Wednesday, February 4, 2009

Accupuncture has no real benefit

Apparently fake acupuncture is as effective as real acupuncture. Unfortunately Michael Kahn of news24 completely missed the boat when he reported on the work of Klaus Linde and the Cochrane Collaboration. Kahn represents Linde's work at the Technical University in Munich as positive for acupuncture when his article claims that acupuncture treatment works "just as well" when the needles are correctly inserted into the hypothetical meridians of ch'i as it does when they are not.

Perhaps Kahn is unaware of what acupuncture actually is, and perhaps he is also woefully ignorant of how scientific trials work. Let me try to clear up some of the confusion, I will start with the acupuncture.

Acupuncture is an ancient medicinal treatment based on the idea that a persons health and well being depend on the uninterrupted flow of an innate life force, a special kind of energy widely known as ch'i, through pathways (known as meridians) in the human body. Acupuncturists pierce the skin with fine needles at important points along the meridians in order to remove blockages and encourage the correct flow of ch'i.

In his excellent book, Bad Science*, Ben Goldacre highlights six central principles of acupuncture. There are many schools of acupuncture and they have evolved slightly different interpretations of ch'i, however they all maintain the following core tenets;

Each meridian is associated with and connects to one of the major organs of the human body.

Each meridian has an internal and external pathway.

There are hundreds of possible acupuncture points along the meridians

Depending on the school and condition being treated, the acupuncturist will insert needles at particular points on particular meridians.

The penetration depth varies from 1cm to 10cm and often the therapy involves rotating the needles in situ.

Needles can be left in place for a few seconds or a few hours.

From the above principles it is abundantly clear that the concept of ch'i and it's pathways throughout the body are absolutely critical to the practice of acupuncture. If your needles are not being placed in the meridians you cannot be influencing the ch'i and you are not performing acupuncture.

Unfortunately for proponents of acupuncture, there is no evidence for the existence of this life energy whatsoever. The very concept of ancient life force was developed in pre-scientific times. People did not understand the way the body works and they came up with the best story which they could to describe what they observed.

Chinese medicine grew up in a society which did not allow human dissection, as such the Chinese medicinal system was based on the world around them. The human body was interpreted as a microcosm of the universe as opposed to understanding it in terms of it's own reality. Having been based on hand waving and story telling, acupuncture is at a very real disadvantage.

In Europe a very different understanding of the human body was developed, one which depends on facts and evidence. A definitive way of winnowing the facts from the tripe is by the use of the randomised controlled trial. The Bandolier journal has published an excellent meta-analysis of clinical trials of acupuncture which helps us to understand how feeble acupuncture is. When Kahn tells us that "Acupuncture prevents headaches and migraines" he is actually asking us to believe something for which there is no convincing evidence at all.

The claim that 'fake' acupuncture has equal benefit to the 'real' thing is utter nonsense. Michael Kahn clearly does not understand the concept of placebo and is too lazy to do a little research. The concept of placebo is a little complex, wikipedia defines a placebo as follows;

The placebo effect is a medical phenomenon in which a physiologically inert treatment, or placebo, improves a patient's condition relative to similar patients who receive no treatment at all. One well-known placebo effect occurs when a patient is treated with an inert pill or a sham surgery. Although these placebos cause no medically relevant changes to the body, patients who are treated with them will improve more on average than patients who receive no treatment. The placebo effect can also be an additional boost for a real therapy or drug beyond that warranted solely by its actual physiological action.

Despite many rigorous trials and years of testing, acupuncture has not been proven to have an effect better than placebo for the ailments it is supposed to be good for. Furthermore, there are numerous complaints which are treated with acupuncture where the treatment has no effect at all. If sham acupuncture is as effective as the real thing, then real acupuncture has no benefit. It is as simple as that.

In his blog, Bad Science, Dr Ben Goldacre discusses this eact topic (and he does it far better than I do). Whilst Dr Goldacre's article takes a close look at the mechanisms of back pain and how simply being in a trial can influence a persons health, I would like you to learn something a little different from mine.

Acupuncture is magical thinking woo-woo science. There is no evidence for it's efficacy. Fake acupuncture, real acupuncture, placebo, what's the difference? There is no difference. Because neither acupuncture nor sham stick-a-needle-anywhere acupuncture has any measurable benefit.

7 comments:

Gina is right, you either got the book title, or the authors wrong. I have read both. Really, really good. In fact, in Trick or Treatment Singh and Ernst state that there is some evidence that acupuncture does seem to work for mild pain and nausea. However, I cannot remember if the tests they cited were double blinded with the aid of the collapsible needles that have been developed by Ernst's team, and others independently. Unfortunately I have already passed the book on to someone else to read so I can't check the details.

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